8/27/2012. Mississippi s Big Problem. An Epidemic Now Reaching Our Children. What Can We Do?

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1 Mississippi s Big Problem. An Epidemic Now Reaching Our Children What Can We Do? Richard D. deshazo, MD Billy S. Guyton Distinguished Professor Professor of Medicine & Pediatrics University of Mississippi Medical Center

2 th Grade 5 Compliments of Jimmy Stewart, MD th Grade MMWR Morb Mortal Wkly Rep 2011; 60: 42 Compliments of Jimmy Stewart, MD 7 8 2

The Recommended Classifications for BMI for ADULTS Adopted by the National Institutes of Health (NIH) and World Health Organization (WHO) Underweight BMI <18. 5 kg/m2 Normal weight BMI 18.5 to 24.

3 The Recommended Classifications for BMI for ADULTS Adopted by the National Institutes of Health (NIH) and World Health Organization (WHO) Underweight BMI <18. 5 kg/m2 Normal weight BMI 18.5 to 24.9 kg/m2 Overweight BMI 25.0 to 29.9 kg/m2 Obesity BMI 30 kg/m2 Obesity Class I BMI of 30.0 to 34.9 kg/m2 Obesity Class II BMI of 35.0 to 39.9 kg/m2 Obesity Class III BMI 40 kg/m2. This type of obesity is also referred to as severe, extreme, or morbid obesity What We Know About Obesity: Things Have Changed Food: Composition and calories Diet Portions Exercise BMI Percentiles CHILDREN BMI 9 10 Mortality Rates as a Function of BMI Ages adjusted for smoking Increasing Body Mass Index (BMI kg/m2), Even Within the Normal Range of BMI (21 to 24.9), is Associated with an Increased Risk of Type 2 Diabetes, Hypertension, Coronary Heart Disease, and Cholelithiasis. Data for women in the Nurses' Health Study, initially 30 to 55 years of age, who were followed for up to 18 years. Data for men in the Health Professionals Follow-up Study, initially 40 to 65 years of age, who were followed for up to 10 years. Ann Intern Med 1985; 103: Lancet 2009; 373: Willett WC, et al. Guidelines for healthy weight. NEJM 1999; 341:

A Range of Diets with Various Fat, Protein, and Carbohydrate Compositions are Effective in Weight Loss and Have Similar Effects at 2 Years NEJM 2009; 360: 859 Mean Change in Body Weight and Waist

Open bars represent average-protein, low-fat, or lowest-carbohydrate diets. T bars indicate standard errors.

4 A Range of Diets with Various Fat, Protein, and Carbohydrate Compositions are Effective in Weight Loss and Have Similar Effects at 2 Years NEJM 2009; 360: 859 Mean Change in Body Weight and Waist Circumference from Baseline to 2 Years According to Dietary macronutrient Content. Solid bars represent high-protein, high-fat, or highest carbohydrate diets. Open bars represent average-protein, low-fat, or lowest-carbohydrate diets. T bars indicate standard errors. Panels A and C show the change in body weight and the change in waist circumference, respectively, for all participants who were randomly assigned to a diet (a total of 811); missing data were imputed. A total of 403 participants were assigned to a high-protein diet and 408 to an average-protein diet, 405 were assigned to a high-fat diet and 406 to a low-fat diet, and 206 were assigned to the highest-carbohydrate diet and 201 to the lowest-carbohydrate diet. Panel B shows the change in body weight for the 645 participants who provided measurements at 2 years. Of these participants 325 were assigned to a high-protein diet and 320 to an averageprotein diet, 319 were assigned to a high-fat diet and 326 to a low-fat diet, and 169 were assigned to the highest-carbohydrate diet and 168 to the lowest-carbohydrate diet. Panel D shows the change in waist circumference for the 599 participants who provided measurements at 2 years. Of these participants, 303 were assigned to a high-protein diet and 298 to an averageprotein diet, 292 were assigned to a high-fat diet and 307 to a low-fat diet, and 159 were assigned to the highest-carbohydrate diet and 155 to the lowest carbohydrate diet. 13 Support Systems are Important in Weight Loss NEJM 2011; 365: Diets Make You Hungry Calorie Restriction in Obese Individuals Results in Compensatory Mechanisms Promoting Weight Regain. These Persist for at Least 12 Months Decreased energy expenditure and increased appetite Decreased leptin 1 Decreased cholecytokinen 2,3 Increased ghrelin 2,4 1. Released from fat and acts in hypothalamus to decrease appetite and increase energy expenditure 2. Released from gastrointestinal tract and pancreas in response to nutrient intake 3. CCK, peptide YY, GLP1, PPP, amylin inhibit food intake 4. Ghrelin stimulates hunger and gastric inhibitory peptide to promote energy storage NEJM 2011; 365: NEJM 2011; 365:

Weight Loss Is Difficult to Sustain Even with Group Support and Exercise, Regardless of Diet Physical Activity and Weight Loss: Evidence From

individuals are unable to exercise enough to effect more than modest weight loss Adding physical activity to calorie restriction offers only a

appears critical for long term weight loss maintenance, but the mechanism for this is unclear NEJM 2009; 360: 859 17 Nature Clinical Practice

5 Weight Loss Is Difficult to Sustain Even with Group Support and Exercise, Regardless of Diet Physical Activity and Weight Loss: Evidence From Randomized Controlled Trials (RCT) Exercise alone produces weight loss proportional to the amount of calories expended only Most obese individuals are unable to exercise enough to effect more than modest weight loss Adding physical activity to calorie restriction offers only a small advantage in most RCT Obese individuals can loose large amounts of weight with dietary restriction alone Physical activity (60-90 min/day) appears critical for long term weight loss maintenance, but the mechanism for this is unclear NEJM 2009; 360: Nature Clinical Practice Endocrinology & Metabolism 2007; 3:518 Arch Int Med 2008; 168: Portion & Calorie Control Fitness Flexibility & Resistance Training 19 Your brand here 20 5

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8 29 30 Self-selected starting point Aerobic component

9 33 34 Southern Remedy s Healthy Living Program is free and printable at To request a CD of the program, please healthyliving@mpbonline.org 35 9

Pharmacotherapy IV: Liraglutide for Chronic Weight Management SARAH CAWSEY MD, FRCPC 2 ND ANNUAL OBESITY UPDATE SEPTEMBER 22, 2018

Pharmacotherapy IV: Liraglutide for Chronic Weight Management SARAH CAWSEY MD, FRCPC 2 ND ANNUAL OBESITY UPDATE SEPTEMBER 22, 2018 Disclosures Faculty Assistant Clinical Professor, Department of Medicine,